320017 12/21/2017 CITY OF CARMEL, INDIANA VENDOR: 371894
ONE CIVIC SQUARE BO-MAR INDUSTRIES, INC. CHECK AMOUNT: $****98,537.31*
CARMEL, INDIANA 46032 3838 S:ARLINGTON AVE. CHECK NUMBER: 320017
INDIANAPOLIS IN 46203 CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 100729 2 98,537.31 MONON STATIC DEVICES
VOUCHER NO. WARRANT NO.. Prescribed by State Board of Accounts: City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor#. 371894.
IN SUM OF.$ CITY OF CARMEL
BO-MAR INDUSTRIES, INC'.
3838 S. ARLINGTON AVE: An invoice or bill to be properly itemized must show;kind ofservice,where performed,dates service...
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46203.
Payee
$98,537.31 .
Purchase Order#
ON ACCOUNT OFAPPROPRIATION FOR
Terms
Redevelopment Commission
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION .
DEPT# INVOICE# Fund#: AMOUNT. s DEPT# FUND#, (or note attached invoice(s)or bill(s)) AMOUNT .
Board Member
100729 2 44-608.07 $98,537:31 . 1 hereby certify that the attached invoice(s),or 11/30/17 2. Center Green signage $98,537.31
902 902 902 902
bill(s)is.(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except.
Monday, December 18, 2017
Mestetsky, Henry
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Clerk-Treasurer
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF t
11/30/1.7 OWNER PERIOD TO!
TO GC- Carmel Redevelopment:Commission APPLICATION NO:: 2 Distribution-to:
OWNER
FROM CONTRACTOR: ARCHITECT
Bo-mar Industries, Inc. PROJECT NO.: ® CONTRACTOR.
3838 S.Arlington Ave.
Indianapolis, IN 46203
CONTRACT FOR Carmel Center-Green Signage CONTRACT DATE: 9/1912017
The undersignedcontractor certifies that to the best of the contractor's knowledge.'Information and belief
CONTRACTOR'S APPLICATION FOR PAYMENT the Work covered by thlsApplieation for Payment:has been completed in accordance with'the
Application is made for payment,as shown below in connection with the Copniract Documents,that all'amounts have been'pafd by the Contractor for Work for which,previous
Contract.Continuation Sheet,AIA Document G703,:is attached. Certificates for Paymentwere issued and payments received from the owner,and that current.
1 ORIGINAL CONTRACT SUM $ 174,354.00 `payment shown herein Is now due.
2 Net change by,Change Orders $ -
3 CONTRACT SUM TO DATE,(tine 1+2) $ 174;354:00 CONTRACTOR: Bo-mar Industries; Inc
4 TOTAL COMPLETED&'STORED TO.DATE $ 123,354.00
(Column G on G763)
5 itETA1NAGE: By: '. - - Date:
a. 10 %of Completed Work 12,335.40 J` uchanan,Treasurer
(Columns D+E on G703)
b. Stored Material % 10 -
(Co(umns F on G703) State.of- Indiana
Total Retainage(line 5a+5b or, County.of: Marion
Total in Column I of G703) $ 12;335:40 Subscribed and sworn'to before
6 TOTAL EARNED LESS RETAINAGE $ 11.1,018.60 me this Z� day ofVQV2MYe>t 2017
(Line 4 less Line 5 Total) _.
7 LESS PREVIOUS.CERTIFICATES,FOR PAYMENT `�e„r♦Iilt+r�s�r���
(Line 6 from prior Certificate) $ 121-481:29 P�vof 11�,
8 CURRENT PAYMENT DUE._ $ 98;537:31 - <<� � �SgtceFXpiq �p�,�.
9 BALANCE.TO'FINISH,INCLUDING RETAINAGE Notary Public: * NOTq 9.
(Line 3 less Line 6 A r Q e
(Li ) $ '63,335:40 ���� r�L
My commission expires; 7,t1. p •, A�gLIG `-
ARCHITECT'S CERTIFICATE FOR.PAYMENT. }•', Y, 9LAZE
In accordance with the'Contract Documents;based on-site observations and the data nPlismit
applicatlon;the Architect certifies to the Owner that to.the best of the Architect7eknowiedge,lnfbr-
mation and belief the work hasprogressed as indicated,the;quality'of,tlte Work is in accordance
wlttithe Contract'Docurnents and Ithe Contractor Gs entitled to payment of the AMOUNT'CERTIFIED.
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AMOUNT.CERTIFIED
Total changes approved in (Attach explanation if amount certified differs ftm the amount applied for.
previous months by Owner
Total approved this Month - AR 'T
TOTALS - B . dA• `-1' r( ,Yt Date:
NET CHANGES by'Change Order - rn. ' "rtifidate is not negotiablei The AMOUNT.CERTIFIED Is payable only to..the Contractor named
herein.Issuance,payment and acceptance of payment are without prejudice to'any rights of the
of the:Owner or Contractorunder this Contract
G703
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 of 2 PAGES
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 2
Contractor's signed Certification is attached. APPLICATION DATE: 11/28/17
In tabulations below,amounts are stated to the nearest dollar. PERIOD FROM: 9/19/17
Use Column I on Contracts where variable retainage for line items may apply. TO: 11/30/17
GC's PROJ NO:
A B C D E 'F G H
ITEM DESCRIPTION of WORK Scheduled Previous THIS APPLICATION Total Completed - % BALANCE RETAINAGE
No. VALUE Application Work in Place Stored Material and Stored (G/C) TO FINISH
1 Sign Type 30 90,454.00 13,568.10 76,885.90 90,454.00 100% = 9,045.40
2 Installation of Sign Type 30 3,000.00 300.00 2,700.00 3,000.00 100% - 300.00
3 Sign Type 20 14,400.00 14,400.00 14,400.00 100% - 1,440.00
4 Sign Type 10/15 60,000.00 12,000.00 12,000.00 20% 48,000.00 1,200.00
5 Installation of Sign Type 10/15 3,000.00 - - 3,000.00 -
6 Bond 3,500.00 - 3,500.00 3,500.00 100% - 350.00
7 C/O-Sign Type 20 2,917.28 - - - 2,917.28 -
TOTAL 177,271.28 13,868.10 109,485.90 - 123,354.00 53,917.28 12,335.40
G702 AND G703 BILLING Pay App 2 11-21-17 Pagel
CONTRACTOR'S AND SUPPLIER'S AFFIDAVIT AND WAIVER OF LIEN
�flrel OPartial 0"ent to Follow
The undersigned,being fust duly sworn on his oath or affirming,states that:
1 Jill Buchanan (Name)is the Treasurer (Title) of
Bo-Mar Industries (Company),(hereinafter called"Company') of and is familiar
with the facts herein stated and makes this affidavit for and on behalf of himself and the Company,being duly
authorized to bind the Company by the statements herein contained.
2 The Company,having contracted with Carmel Redevelopment Commission has performed work and labor
or famished materials supplies'or equipment in the construction of certain improvements on the real estate commonly
known as Carmel Center Green Signage located at Carmel Center Green in,
Carmel (City), IN (State),which real estate is owned by
Carmel Redevelopment Commission (hereinafter called"Owner").
3 Company has,or will within 10 days of receipt of payment due from Carmel Redevelopment Commission noted in Item 4,
paid for all work,labor,materials,equipment,and suppliers performed or famished by it and by its subcontractors,material-men
and suppliers upon such premises or in connection therewith and no person,other than Company,has any claim or right to alien
for any work,materials or services on account of any transaction undertaken by company with respect to said premises,
except as specifically noted below;
Name of Company Amount Owed Explanation for Withholding Payment
NONE
4 The amount due to Company from Carmel Redevelopment Commission
PARTIAL WAVIER that the balance due is the sum of:
Ninety-Eight Thousand Five-Hundred Thirty-Seven and 31/100 ( $ 98,53731 )
❑ receipt of which is hereby acknowledged,or
d the payment of which is promised as the sole consideration for this Affidavit and Partial and Waiver of Lien which is given
to and for said amount,effective upon receipt of such payment.
FINAL WAIVER that the final balance due is the sum of:
❑ receipt of which is hereby acknowledged,or ( )
❑ the payment of which is promised as the sole consideration of this affidavit and Final Waiver of Lien which shall become effective
upon receipt of such payment.
THEREFORE,the undersigned waivers and releases under the statutes of the state of Indiana,unto the Owner
of said premises,any and all lien of claim whatsoever on the above-described property and improvements thereon account of LABOR
or material or both,furnished by the undersigned thereto,and further certifies that no other party has any claim or right to alien on account
of any work performed ormaterial famished to the undersigned for said project,except as noted above,and within the scope of this
affidavit and waiver.
Bo-M Industries,Inc.
(Co pa Na
Title: Treasurer
(Si re of of`icer)
Subo bed and om before me this 28th day of November 2017
County of Residence: Marion
(Notary Public)
4/24/2025 ,,1111111 f�f
(My Commission Expires) ,,`%"% � ARS/���,
j0TARY dZ
SEAL
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